Talk:Transcranial magnetic stimulation/Archive 1

Consumer TMS IS Available
There is an extremely affordable TMS device ("Shakti") available from www.shaktitechnology.com that I recently ran across and ordered for my own experiments. The 4-coil device was only about $100. 2-coil versions are around $60-70 and 8 coil devices are around $200-250. It came with software (since replaced by a much more effective version), and took some time to figure out, but it seems to be producing some interesting results. The device was developed by Todd Murphy, a Behavioral Neuroscientist associated with Dr. Michael Persinger of Laurentian University in Canada. It was created for the purpose of exploring the "spiritual aspects" of neuroscience. It allows one to apply signals derived from the Amygdala, Hippocamus, and other limbic-system modules of the brain, which can then be applied to a number of areas of the cortex, such as the temporals, parietals, pre-frontal, etc. My first experience was from applying an Amygdaloid signal to the left temporals. I noticed afterward a fairly pronounced feeling of well-being. I then applied the same signal to both the left and right pre-frontal cortex, followed by a Hippocampal signal to the same region. I actually exceeded the recommended session parameters but following this approach, but did not wish to wait the suggested 72 hours between sessions. The most interesting thing that I noticed after the sessions was that, in addition to feeling quite upbeat, I started to immediately try to complete tasks I had been putting off for weeks. I almost felt obsessive about doing these tasks. I also noticed that I had an unending stream of ideas flowing through my head which continued for several days straight. It was like a miniature personal renaissance. I will wait until the 72 hours is up before trying any more experiments, but I think this is quite promising.

NOTE: Shakti is NOT TMS. Shakti uses different principles and magnetic fields much fainter than the ones used in TMS. TMS uses simple signals (Pulses) while Shakti uses "complex" magnetic signals.

—Preceding unsigned comment added by 66.26.245.206 (talk) 11:22, 24 November 2007 (UTC)

What is an "Amygdaloid signal"? A signal that is meant to replicate a signal originating in the amygdala? Nina137.111.47.29 (talk) 05:20, 19 December 2008 (UTC)

Question
Does anyone know the resolution of this technique (i.e. how small an area of the brain may be targeted)? Eldereft 05:28, 3 November 2005 (UTC) The interesting thing is that literature on this subject measures the affected brain in cm^2. Typical value is approximately 1-2cm^2. I don't know how deep it goes, but I'm guessing around 1cm. So around 2cm^3 of affected volume in the 90% power zone. The technique will never be able to target more locally than this, since there is no such thing as a magnetic monopole. The technique will never be able to locally target an area inside the brain. The closer to the surface of the scalp the focus of the magnetic field is, the higher the resolution can be. If you want to target the center of the brain, you will not be able to do so without also targeting the rest of the brain. Personally, I think this technique will never develop beyong a curiousity, and perhaps zapping people who already have a problem, where "it can't get any worse... so zap away" will take over (as it did for electroshock). —Preceding unsigned comment added by 82.75.128.73 (talk) 14:14, 17 February 2008 (UTC)

Homemade Devices
A while back I stumbled into some sites about homemade TMS devices, I remeber they were basicly a wood rod with magnets on its tips and conected to some sort of bearings in the middle, most were hand cranked. But I seem to be unable to find the said sites, nor any other with instructions on this, does any one knows where I can find something in those lines? TiagoTiago 21:24, 2 June 2006 (UTC)


 * Forget it. You are talking about a device costing 10s of thousands of dollars. The magnetic field strength needed to have any effect on the cortex requires 1000s of amps - not something involving 'a wood rod with magnets on its tips'. Sorry.


 * This is a sham, and would be something like going to a do-it-yourself ECT operator. Though it is more or less a noninvasive procedure, it is certianly not something people want to be fooling around with items "built" from componenents ordered from the Web or the back of a magazine.  And as FDA approval becomes more and more imminent -- Neuronetics' TMS device may receive FDA approval by the end of October '06 -- and it becomes more of an acknowledged mode of treatment, regulations will come into place.  --Markt3 05:41, 26 September 2006 (UTC)

Actually, it's not that hard to generate 1000's of amps as long as it is for short periods of times (microsecond pulses for example). Many "home built" laser and other projects involving high current short duration pulses are affordable and doable by anyone with an electronics or engineering background. They can be dangerous of course. First thing you need to understand is the actual specifications for this device. What is the current pulse/duration/frequency being used to make this thing work. Then you could look at power supply kits online for things like pulsed lasers, electromagnetic rail guns, etc. —Preceding unsigned comment added by 75.100.147.106 (talk) 15:20, 14 August 2010 (UTC)

Consumer availability
Are there any rTMS devices on the market for purchase by consumers? (if so, at what prices?) Anarchist42 23:28, 19 January 2006 (UTC)

No. TMS is a medical device and can only be used by a qualified physician.
 * This is flase. You do not need to be a physician to use a TMS device; they are allowed in research settings by trained users as well. Often you are required to have CPR certification as well, however. S  e  miconscious  •  talk  17:47, 24 January 2006 (UTC)
 * In other words it is not really available as a treatment for depression (a shame, it would be easier than pouring cold water into my ear). Anarchist42 19:41, 24 January 2006 (UTC)
 * Well, no quite true either. Using TMS to treat depression is valid in theory, and there is some good evidence supporting this, but it's still in the experimental phase right now. You could always volunteer for a research study at a local university or something if they're conducting anything. However expect to wait a while before you can go into any doctor's office and get TMS for depression. S  e  miconscious  •  talk  21:21, 24 January 2006 (UTC)
 * Actually there are a small but growing number of sites that offer TMS in a clinical outpatient settings. It is done as an off-label procedure, which means that insurance will not cover it, and it tends to be pricey (e.g. $250 - 350 per session for a two or three-week induction period.  It it proves successful in a given patient, an ongoing maintenance regimen would be worked out (similarly to ECT), with patients receiving regular treatments on an indefinitely basis.  Pricey, but cheaper than ECT, in that patient does not need to be admitted, no ansthesia is required, etc.--Markt3 05:36, 26 September 2006 (UTC)
 * I've read the studies, and it seem clear to me that TMS should indeed be a very effective (and non-pharmaceutical) treatment option. Since TMS puts no money into the coffers of pharmaceutical corporations, I doubt it will ever be approved. Anarchist42 21:39, 24 January 2006 (UTC)
 * It's not as simple as you may think. Just because it seems clear to you doesn't mean it is an approved treatment option. People still don't know what TMS does to the brain over prolonged usage. The neural effects are being researched right now. People also don't know what's going on in the brain to alleviate symptoms of depression. A lot of research is being done on this. Making the assumption that the pharmaceutical industry is somehow supressing the treatment is rather broad; there are a lot of people working on this field of research right now, and a lot of people stand to make money off of it. The FDA needs to be shown that it is more safe and effective over other treatments that carry less risk (i.e., seizure). S  e  miconscious  •  talk  21:57, 24 January 2006 (UTC)
 * I'd had enough experience with (sometimes bogus) "approved treatment options", as well as (sometimes effective) "non-approved treatment options" to be less interested in "official approval" than in actual efficacy. Anarchist42 22:52, 24 January 2006 (UTC)
 * I'm sorry to hear that. Unfortunately we as individuals can't judge efficacy right now. S  e  miconscious  •  talk  23:10, 24 January 2006 (UTC)
 * Perhaps many individuals can't, but I'm quite capable of understanding research studies and filtering out bias and statistical flaws - my experience with psychiatrists is that they tend not to be so capable. Anarchist42 23:59, 24 January 2006 (UTC)

There is a new product that is in for FDA appoval please see link. http://www.neuralieve.com/

Anonymous Comment
Since the TMS is essentialy inducing electrical signals in the brain through the use of powerful magnetic fields, could it theoretically restart the brain of a patient who has died and is now otherwise in good condition?

Like say a heart attack. Could they keep the patient on ice and a machine that keeps the blood flowing and oxygenated and then use TMS to restart the brain? - June 9th 2006

I doubt it would reach the parts of the brain that would need to be "restarted" (brain stem etc), though even if it could I doubt it would have much effect on whatever it was that had caused the brain to stop in the first place. Nina137.111.47.29 (talk) 05:25, 19 December 2008 (UTC)

References from Brain-computer interface page
I had archieved the references below from the Brain-computer interface page as they were off topic. Reviewing them now, they mostly seem to relate to magnetic stimluation of the brain and are published in scholarly journals so I'm posting them here in case they help. Cheers--Saganaki- 03:08, 12 October 2006 (UTC)


 * Arber, S.L., J.C. Lin, Microwave Effects on Helix Asperse Neurons, Fourth Ann. Mtg. Bioelectromagnetics Soc., Los Angeles, CA, June 1982.
 * Arber, S.L. and J.C. Lin, Role of External Calcium in Microwave-Induced Snail Neuron Response, Fifth Ann. Scientific Session Bioelectromagnetic Soc., Boulder, CO, June 1983.
 * Caldwell, L.R., J.C. Lin and A.W. Guy, Behavioral Changes of Rats Exposed to Microwave Radiation, IEEE S-MTT International Symp., Atlanta, GA, June 1974.
 * Dalecki,D., Child, S.Z., Raemanand, C.H. and Carlstensen, E.: Tactile perception of ultrasound, Journal of acoustical society of America, pp3165-3170,1995.
 * J.Edrich and T.Zhang: Ultrasonically Focused Neuromagnetic Stimulation, Proceeding of the Annual Conference on Engineering in Medicine and Biology, v15. pt3, pp.1253-1254,1993.
 * Fetz E.E., Baker M.A. (1973) Operantly conditioned patterns on precentral unit activity and correlated responses in adjacent cells and contralateral muscles. J Neurophysiol. Mar;36(2):179-204.
 * Gavrilov, L.R., Tsirulnikov, E.M., and Davies, I.：Application of Focused Ultrasound for The Stimulation of Neural Structures, Ultrasound in Medicine & Biology,Vol.22,No2, pp.179-192,1996
 * Ginsburg, K., J.C. Lin and W.D. O'Neill, Microwave Effects on Spiking Statistics of Single Neurons, BEMS Ninth Annual Meeting Program, Portland, Oregon, June 1987.
 * Ginsberg, K.S., J.C. Lin, S. Murphy, and M.F. Lin, Microwave Effect On Input Resistance And Action Potential Firing Of Snail Neurons, IEEE Trans. Biomed. Eng., Vol. 39, pp. 1011-1021, 1992.
 * Guy, A.W. and J.C. Lin and F.A. Harris, The Effect of Microwave Radiation on Evoked Tactile and Auditory CNS Responses in Cats, International Microwave Symp., Ottawa, Canada, May 1972.
 * Guy, A.W., E.M. Taylor, B. Ashleman and J.C. Lin, Microwave Interaction with the Auditory Systems of Humans and Cats, IEEE G-MTT Int. Microwave Symp., Univ. of Colo., Boulder, CO, June 1973.
 * Guy, A.W., C.K. Chou, J.C. Lin and D. Christensen, Microwave Induced Acoustic Effects in Mammalian Auditory Systems and Physical Materials, N.Y. Acad. Sci. Conf. Biol. Effects of Nonionizing Radiation, New York, Feb. 1974.
 * Lin, J.C. and J. Salinger, Microwave Measurement of Respiration, IEEE S-MTT International Microwave Symp., Palo Alto, CA, May 1975.
 * Lin, J.C. and C.K. Lam, A Theoretical Study of Microwave Generated Auditory Phenomena in Mammalian Cranial Structures, USNC/URSI - Biological Effects Series, Boulder, CO, Oct. 1975.
 * Lin, J.C., Predicted Frequency and Threshold of Microwave-Induced Auditory Sensation, USNC/URSI - Biological Effects Series, Amherst, MA, Oct. 1976.
 * Lin, J.C., E. Dawe and J. Majcherek, A Noninvasive Microwave Apnea Detector, San Diego Biomedical Symp., San Diego, CA, Feb 1977.
 * Lin, J.C., R.J. Meltzer and F.K. Redding, Microwave Evoked Potentials in Cats, San Diego Biomedical Symposium, San Diego, CA, Feb. 1978.
 * Lin, J.C., R.J. Meltzer and F.K. Redding, Characteristics of Microwave Auditory Effects: Theory and Experiments, URSI Open Symp. on Biological Effects of Electromagnetic Waves, Helsinki, Finland, August 1978.
 * Lin, J.C., S.L. Arber, Response of Snail Nerve Cells to Noise Modulated Microwave Field, Fourth Ann. Mtg. Bioelectromagnetic Soc., Los Angeles, CA, 1982.
 * Lin, J.C. and Charles C. Thomas, Microwave Auditory Effects And Applications, Publisher, Springfield, IL 1978, 221 pp.
 * Lin, J.C., Electromagnetic Interaction with Nervous System Structure and Function, IEEE Engg. in Biology Conf., Chicago, IL, September 1985.
 * Lin, J.C., J.L. Su and Y. Wang, Measurement of Microwave-Induced Thermoelastic Pressure Wave Propagation in Cat Brains, Ann. Meeting of the Bioelectromagnetic Society, Madison, WI June 1986.
 * Lin, J.C. W.D. O'Neill, A. Field and K. Ginsburg, Pulsed High Power Microwave Effects on Spontaneous Firing Activities of Snail Neurons, BEMS Ninth Annual Meeting, Portland, Oregon, June 1987.
 * Ma, Y.C., J.C. Lin, W.D. O'Neill and S. Arber, Real Time Processing of Neuronal Response to Microwave, IEEE Engg. Medicine Biol. Conf., Los Angeles, CA, September 1984.
 * R.T.Mihran, F.S.Barnes, H.Wachtel: Temporally-Specific Modification of Myelinated Axon Excitability in vitro Following A Single Ultrasound Pulse, Ultrasound in Medicine & Biology, Vol.16, No.3, pp.297-309, 1990
 * Nefcy, P.M. and J.C. Lin, A Model for Auditory Evoked Potentials, Annual Conf. on Engg. in Medicine and Biology, Atlanta, Georgia, Oct. 1978.
 * Neilly, J.P., V. Kriho, S.L. Arber and J.C. Lin, Ultrastructural Studies of Microwave Irradiated Snail Nerve Cells, Fifth Ann. Scientific Session Bioelectromagnetics Soc., Boulder, CO, June 1983.
 * Popovic, M.A., K.H. Chan and J.C. Lin, Microprocessor Based Non-Contact Heart Rate/Respiration Monitor, IEEE Eng. Medicine Biol. Conf., Los Angeles, CA, September 1984.
 * Taylor, E.M., A.W. Guy, B. Ashleman and J.C. Lin, Microwave Effects on Central Nervous System Attributed to Thermal Factors, IEEE G-MTT Int. Microwave Symp., Univ. of Colo., Boulder, CO, June 1973.
 * Wu, C.L. and J.C. Lin, Interaction of Modulated Electromagnetic Fields with Nervous Structures, USNC/URSI - Biological Effects Series, Boulder, CO, Oct. 1975.

Side effects
There are prominent side effects associated with ECT. Does TMS have none?--Loodog 03:56, 20 July 2007 (UTC)

As a patient of right-side 1 Hz. TMS since 1998 (for depression at Beth Israel Deaconess with Dr. Alvaro Pascual-Leone), it does give me migraines, but I know that I am an extreme case. That is not true for most patients. (I am prone to migraines.) I do feel my facial muscles twitch during treatments, but that isn't at all painful. No memory problems whatsoever. The risk of seizure has been exagerated due to researchers using the equipment inappropriately. From what I've been told, no patient has ever experienced a seizure. —Preceding unsigned comment added by 66.30.42.7 (talk) 00:04, 16 January 2008 (UTC)


 * As far as I know, TMS doesn't have the memory disturbance associated with ECT. However, I believe there is a risk of seizure as well as temporary language switching in bilingual people. Beyond that I'm not sure. Nathanaver 04:13, 20 July 2007 (UTC)

According to the [http://elata.org/tms-faq.shtml#_Is_TMS_safe? Elata Foundation], there are not substantial side effects beyond headache and a very small risk of seizure.--Gloriamarie 23:40, 31 July 2007 (UTC)

TMS can cause facial muscles to twitch, and if the machine is used at high power this can be painful. Frontal stimulation sites (as used to treat depression) tend to be most painful. Can't find a reference immediately but I've experienced it myself. AFdeCH 21:37, 10 August 2007 (UTC)

'''I am rewriting the page as it is almost totally incomprehensible now with people adding every single minor trial into it. I have removed most of the trials and just given a cursory overview of the trials. I have re-ordered some of the headings and added a few more bits of technical information. This is what I have...'''  Give me some feedback  --Grushnik 12:42, 15 August 2007 (UTC)    Transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a noninvasive method to excite neurons in the brain. The excitation is caused by weak electric currents induced in the tissue by rapidly changing magnetic fields (electromagnetic induction). This way, brain activity can be triggered or modulated without the need for surgery or external electrodes. This is used to study the circuitry and connectivity of the brain. Repetitive transcranial magnetic stimulation is known as rTMS and can produce longer lasting changes. Numerous small-scale pilot studies have studies have shown it could be a treatment tool for various neurological conditions (e.g. migraine, stroke, dystonia), but as yet no large scale trial has been done, the therapeutic potential of rTMS should not be considered proven.

Contents

1.	Background

2.	How TMS affects the brain

3.	Technical information on TMS

4.	TMS and rTMS in research

5.	TMS and rTMS techniques in research

6.	Risks of TMS and rTMS

7.	Clinical uses of TMS and rTMS

8.	TMS equipment

9.	Technical information on TMS

10.	References

11.	See also

12.	External links

Background

The principle of inductive brain stimulation with eddy currents has been noted since the 19th century. The first successful TMS study was performed by Anthony Barker et al.[2] in Sheffield, England. Its earliest application was in the demonstration of conduction of nerve impulses from the motor cortex to the spinal cord. This had been done with transcranial electrical stimulation a few years earlier, but use of this technique is limited by severe discomfort. By stimulating different points of the cortex and recording responses, e.g., from muscles, one may obtain maps of functional brain areas. By measuring EEG, information may be obtained about the healthiness of the cortex (its reaction to TMS) and about area-to-area connections.

It is also important to distinguish TMS from repetitive TMS (rTMS) as they are used in different ways for different purposes.

How TMS affects the brain

The exact details of how TMS functions are still being explored. The effects of TMS can be divided into two types depending on the mode of stimulation:

•	Single or paired pulse TMS. The pulse(s) causes a population of neurons in the neocortex to depolarise and discharge an action potential. If used in the primary motor cortex, it produces a motor-evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, phosphenes (flashes of light) might be detected by the subject. In most other areas of the cortex, the participant does not consciously experience any effect, but his or her behaviour may be slightly altered (e.g. slower reaction time on a cognitive task), or changes in brain activity may be detected using Positron Emission Tomography or fMRI. These effects do not outlast the period of stimulation. A review of TMS can be found in the Handbook of Transcranial Magnetic Stimulation.[4]

•	Repetitive TMS (rTMS) produces effects which last longer than the period of stimulation. rTMS can increase or decrease the excitability of corticospinal or corticocortical pathways depending on the intensity of stimulation, coil orientation and frequency of stimulation. The mechanisms of these effects are not clear although it is widely believed to reflect changes in synaptic efficacy akin to long-term potentiation (LTP) and long-term depression (LTD). A recent review of rTMS can be found in Fitzgerald et al, 2006.[5]

TMS and rTMS in research

Pioneers in the use of TMS in neuroscience research include Anthony Barker, Vahe Amassian, John Rothwell of the Institute of Neurology, Queen Square, London, Mark S. George, MD of the Medical University of South Carolina, David H. Avery, MD of the University of Washington at Seattle, Charles M. Epstein of Emory University, Drs. Mark Hallett, Leonardo G. Cohen, and Eric M. Wassermann of the National Institutes of Health, and Alvaro Pascual-Leone of Harvard Medical School. Currently, thousands of TMS stimulators are in use. More than 3000 scientific publications have been published describing scientific, diagnostic, and therapeutic trials.

TMS and rTMS techniques in research

One reason TMS is important in neuroscience is that it can demonstrate causality. A noninvasive mapping technique such as fMRI allows researchers to see what regions of the brain are activated when a subject performs a certain task, but this is not proof that those regions are actually used for the task; it merely shows that a region is associated with a task. If activity in the associated region is suppressed (‘knocked out’ or ‘lesioned’) with TMS stimulation and a subject then performs worse on a task, this is much stronger evidence that the region is used in performing the task.

''For example: subjects asked to memorize and repeat a stream of numbers 	would likely show, via fMRI, activation in the prefrontal cortex (PFC), which seems to be important in short-term memory. If the researcher then 	interfered with the PFC via TMS, the subjects' ability to remember numbers 	would decline, and the researcher would have evidence that the PFC is 	important for short-term memory, because reducing subjects' PFC capability 	led to reduced short-term memory.

This ‘knock-out’ technique can be done in two ways:''

1.	Online TMS: where subjects perform the task and at a specific timepoint (usually in the order of 1-200ms) of the task, a TMS pulse is given to a particular part of the brain. This should affect the performance of the task specifically, and thus demonstrate that this task involves this part of the brain at this particular time point. The advantage of this technique is that any positive result can provide a lot of information about how and when the brain processes a task, and there is no time for a placebo effect or other brain areas to compensate. The disadvantages of this technique is that one has to know roughly when the part of the brain is responsible for the task so lack of effect is not conclusive.

2.	Offline repetitive TMS: where performance at a task is measured initially and then repetitive TMS is given over a few minutes, and the performance is measured again. This technique has the advantage of not requiring knowledge of the timescale of how the brain processes. However repetitive TMS is very susceptible to the placebo effect. Additionally, the effects of repetitive TMS are variable between subjects and also for the same subject.

A variant of this technique is the ‘enhancement’ technique, where repetitive TMS is delivered to enhance performance. This is even harder to achieve than the ‘knock-out’ technique.

Risks of TMS and rTMS

As it induces an electrical current in the human brain, TMS and rTMS can produce a seizure. The risk is very low with TMS except in patients with epilepsy and patients on medications. The risk is significantly higher in rTMS especially when given at rates >5Hz at high intensity.

The only other effects of TMS which are reported in most subjects are:

•	discomfort/ pain from the stimulation of the scalp and associated nerves on the overlying skin

•	hearing from the loud click made by the TMS pulse

Clinical uses of TMS and rTMS

The uses of TMS and rTMS can be divided into:

•	Diagnostic

•	Therapeutic

TMS for diagnosis

TMS is used currently clinically to measure activity and function of specific brain circuits in humans. The most robust and widely-accepted use is in measuring the connection between the primary motor cortex and a muscle (i.e. MEP amplitude, MEP latency, central motor conduction time). This is most useful in stroke, spinal cord injury, multiple sclerosis and motor neuron disease. There are numerous other measures which have been shown to be abnormal in various diseases but few are validated or reproduced and more importantly, no one knows the significance of it. The most famous is short-interval intracortical inhibition (SICI) which measures the internal circuitry (intracortical circuits) of the motor cortex (Kujirai et al., 1993).

Plasticity of the human brain can also be measured now with repetitive TMS (and variants of the technique, e.g. theta-burst stimulation, paired associative stimulation) and it has been suggested that this is the primary abnormality in a number of conditions.

TMS for therapy

It is important to stress that there is no strong evidence for the use of TMS for therapy of any condition. A large number of studies with TMS and repetitive TMS has been conducted for a variety of neurological and psychiatric conditions but few have been confirmed and most show very modest effects if any. Some conditions which have been reported (but not proven) to be responsive to TMS-based therapy are:

•	Stroke

•	Tinnitus

•	Parkinson’s Disease

•	Dystonia

•	Epilepsy

•	Migraine

•	Dysphasia

•	Neglect

•	Chronic pain

•	Depression

It is important to stress that in a vast majority of these studies, no adequate control of placebo effect was possible and thus it is tempting to wonder if this effect is placebo.

Technical information on TMS

TMS is simply the application of the principle of induction to get electrical current across the insulating tissues of the scalp and skull without discomfort. A coil of wire, encased in plastic, is held to the head. When the coil is energized by the rapid discharge of a large capacitor, a rapidly changing current flows in its windings. This produces a magnetic field oriented orthogonally to the plane of the coil. The magnetic field passes unimpeded through the skin and skull, inducing an oppositely directed current in the brain that flows tangentially with respect to skull. The current induced in the structure of the brain activates nearby nerve cells in much the same way as currents applied directly to the cortical surface. The path of this current is complex to model because the brain is a non-uniform conductor with an irregular shape. With stereotactic, MRI-based control the precision of targeting TMS can be approximated to a few millimeters (Hannula et al., Human Brain Mapping 2005).

Typical data:

Magnetic field: often about 2 tesla on the coil surface and 0.5 T in the cortex

Current rise time: zero to peak, often around 70-100 microseconds

Waveform: monophasic or biphasic

TMS equipment

The major manufacturers for general purpose TMS and repetitive TMS equipment are:

•	The Magstim Company, UK

•	Medtronics, USA

•	Cadwell, USA

•	Dantec, Denmark

•	Schwarzer, Germany

Several TMS/rTMS devices are approved by the US Food and Drug Administration (FDA) for stimulation of peripheral nerve and, therefore, can be used "off label" by individual physicians to treat brain disorders, essentially in any way they believe appropriate, analogous to the off label use of medications. However, most legitimate use of TMS in the US and elsewhere is currently being done under research protocols approved by hospital ethics boards and, in the US, often under Investigational Device Exemption from the FDA. The requirement for FDA approval for research use of TMS is determined by the degree of risk as assessed by the investigators, the FDA, and the local ethics authority. An application for clearance of TMS Therapy as a treatment for depression was submitted to the FDA in 2006. The FDA convened its Neurological Devices Panel on January 26, 2007 to review the TMS Therapy application. The results of this panel meeting were mixed with no concerns regarding the safety of this treatment, however, there was clear questioning of the efficacy of this treatment [7]. A final decision from the FDA in regard to approving TMS as a treatment for depression is expected in the first half of 2007. As regulated medical devices, TMS devices are not sold to the general public. They are also expensive (US$25,000-100,000; together with state-of-the-art targeting and recording instruments, up to about US$500,000). In Europe, TMS devices that have been manufactured according to the Medical Device Directive have been granted the CE mark and can thus be freely marketed within the EU.

References

[1] Ebmeier and Hermann (December 2006). "Factors Modifying the Efficacy of Transcranial Magnetic Stimulation in the Treatment of Depression: A Review". Journal of CLinical Psychiatry.

[2] Barker AT, Jalinous R, Freeston IL. (1985). "Non-invasive magnetic stimulation of human motor cortex.". Lancet 1: 1106-1107.

[3] (May 22, 2007) "NeuroStar(R) TMS Therapy Improved Quality Of Life In Patients With Major Depression In Clinical Trials".

[4] Pascual-Leone A, Davey N, Rothwell JC, Wassermann EM, Puri BK (2002). Handbook of Transcranial Magnetic Stimulation.

[5] Fitzgerald PB, Fountain S, Daskalakis ZJ (2006). "A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition". Clinical Neurophysiology.

[6] "TMS terminology", BioMag Laboratory at Helsinki University Central Hospital

[7] Bridges, Andrew (January 2007). "Panel questions magnet therapy results".

See also

•	Cranial Electrotherapy Stimulation (CES)

•	Transcranial direct current stimulation (tDCS)

•	Electroconvulsive therapy (ECT)

External links

•	CIMIT - Center For Integration Of Medicine And Innovative Technology

•	Recording of EEG response due to TMS

•	Transcranial magnetic stimulation in psychiatry

•	BioMag Laboratory, Helsinki

•	OpenStim: The Open Noninvasive Brain Stimulator

•	MagVenture: Magnetic Stimulation - Principles

•	Magnets may make the brain grow stronger

•	Elata Foundation non-profit for TMS development and education

Different View Point
From what I have read on this subject, which is admittedly very little, all those experimenting with this theory are from the medical background. Is there any research that include Electrodynamicists or at least Electrical Engineers or Physicists with a background in electromagnetics? I have yet to see any reference to either near field strength, frenel zones, or Fraunhofer region power densities. To be very honest, it seems that medical industry is once again not practicing the scientific method and only testing outcome without defining variables. If anyone has any reference to in-depth electromagnetic modeling (yes it can be done with programs like HFSS, FEKO, or WIPL-D depending on what method you prefer on very customized clusters or high end computers), it would be very interesting to read. If one could understand the entire body as a system, and its associated subsystems in a meaningful way by defining it within the boundaries (used loosely here) of electromagnetics, then they would open a whole line in treatments and would most likely have less side affects than current pharmaceuticals solutions. Again, any references to well defined research from the electrodynamics view point would be very helpful. —Preceding unsigned comment added by Cwru53 (talk • contribs) 02:26, 11 November 2007 (UTC)

Yes, see for example Roth, B. J., J. M. Saypol, L. G. Cohen and M. Hallett, 1991, A theoretical calculation of the electric field induced in the cortex during magnetic stimulation. Electroenceph. clin. Neurophysiol., 81:47-56. Magnetic stimulation occurs at low enough frequencies that all the electromagnetic wave phenomena you mention--Fresnel zones, Fraunhofer regions--are not important. Both the wave length and even the skin depth are large compared to the body size. Magnetic stimulation is to a very good approximation quasistatic. —Preceding unsigned comment added by Rothbrad (talk • contribs) 01:07, 9 July 2009 (UTC)

Why is rTMS knockout research suseptible to the placebo effect?
The section TMS and rTMS techniques in research, and bullet point Offline repetitive TMS contains the statement, "However repetitive TMS is very susceptible to the placebo effect." Unfortunately this statement is unreferenced. I'm wondering why the statement should be so. Couldn't you preform sham rTMS treatments on the subjects, including simulated noises? If the subject can detect the actual treatment it would be more difficult; you would have to knockout another portion of the brain you're reasonably certain how no relationship to the task you are studying. Does anyone have a reference supporting this statement? --Lostart (talk) 19:20, 26 December 2007 (UTC)

Firstly, simulated noises have been used in sham coils, but these do not provide the tactile scalp sensation of rTMS. I believe Prof Lisanby has produced a sham coil which also attempts to deliver a tactile scalp sensation by also electrically stimulating the scalp nerves to mimic the sensation. This coil is not widely available however. Also suprathreshold stimulation is very difficult to sham particularly if they involve the motor cortex as these forms of real stimulation produce very obvious arm or leg twitches. One could argue that a patient blind to real rTMS would not know what real rTMS feels like; this is a valid argument only in experiments which ensure that patients are blind to real rTMS and are assessed for blinding.

Also, see this reference which directly addresses why the placebo effect is very relevant when talking about rTMS:

'''Strafella AP, Ko JH, Monchi O. Therapeutic application of transcranial magnetic stimulation in Parkinson's disease: the contribution of expectation. Neuroimage. 2006 Jul 15;31(4):1666-72. Epub 2006 Mar 20.'''

Repetitive transcranial magnetic stimulation (rTMS) is a valuable probe of brain function. Ever since its adoption as a research tool, there has been great interest regarding its potential clinical role. Presently, it is unclear whether rTMS will have some role as an alternative treatment for neuropsychiatric and neurological disorders such as Parkinson's disease (PD). To date, studies addressing the contribution of placebo during rTMS are missing. The placebo effect has been shown to be associated either with release of dopamine in the striatum or with changes in brain glucose metabolism. The main objective of this study was to test whether, in patients with PD, the expectation of therapeutic benefit from rTMS, which actually was delivered only as sham rTMS (placebo-rTMS) induced changes in striatal [11C] raclopride binding potentials (BP) as measured with positron emission tomography (PET). Placebo-rTMS induced a significant bilateral reduction in [11C] raclopride BP in dorsal and ventral striatum as compared to the baseline condition. This reduction BP is indicative of an increase in dopamine neurotransmission. The changes in [11C] raclopride binding were more evident in the hemisphere contralateral to the more affected side supporting the hypothesis that the more severe the symptoms, the greater the drive for symptom relief, and therefore the placebo response. This is the first study addressing the placebo contribution during rTMS. While our results seem to confirm earlier evidence that expectation induces dopaminergic placebo effects, they also suggest the importance of placebo-controlled studies for future clinical trials involving brain stimulation techniques.

Regards. --Grushnik —Preceding comment was added at 13:12, 28 January 2008 (UTC)

Investigation of attentional processes
User:Thedustbuster, as you will see from the history, the material you are disputing was added by me and was a summary of the article in "The Psycholgist", as clearly stated. I regarded my version as an honest and accurate summary of the facts in that article. I have no wish to plagiarise Mr Chambers and colleagues, nor to embarrass the BPS, nor to harm "The Psychologist". Please could you outline where you feel the plagiarism exists and/or suggest any better summary? Martinevans123 (talk) 19:55, 12 August 2008 (UTC)

I have removed the section again. Since User:Thedustbuster as someone involved with the original paper has claimed a copyvio, the burden of proof should lie on the contributor, not otherwise. Gunnar Hendrich (talk) 21:48, 12 August 2008 (UTC)


 * Sincere apologies for a lazy edit that has now been construed as a deliberate act of harm against the publisher, seemingly. My desire to provide a strong but popular source has rather backfired. It is sometimes difficult to find "own words" that convey the same meaning as a scientific article. It's also hard to know what to leave out when one is interested in the subject matter. But I notice that Thedustbuster suddenly becomes plural on your talk page User:Gunnar Hendrich and thus both more legal and more threatening, seemingly. I may attempt a much briefer and less interesting edit when I can, seemingly. Martinevans123 (talk) 22:08, 12 August 2008 (UTC)

Overstatement of both risks and benefits
I'll provide the supporting references and make the changes to the article when I get the chance but I think both the risks and benefits of TMS have been overstated. I'm not sure what the case is in general practice but I know that in research there are groups of people for who TMS is contraindicated eg people with epilepsy or metal objects in their head, but TMS is regarded as safe for the normal population with the majority of people experiencing no side effects beyond a sensation of tap on the head which is typically not percieved as painful. The risk of a seizure following the use of single/paired pulse in a person with no contraindicated conditions is extremely low. The impression I get from this, 1998 article is that seizures resulting from single pulse TMS in normal individuals have only occured in patients with prexisting conditions that affect the nervous system, Wassermann 1998. I intend to replace the MayoClinic reference(who knows where they get their information?) with this article and other similar safety article. I also do not think the long term effects of TMS are unknown. TMS has been around for a while now and if no long term effects have been reported I think its fairly safe to say there are no long term effects. The may article is a little misleading here. The changes in the brain function with single/paired pulse TMS are transient. rTMS may be a different story but changes in brain function does not imply negative long term side effects. The electromagnetic fields (which the Mayo article suggests may be dangerous) are also on par with or lower than MRI, which also has not shown any negative long term effects.

On to treatments. As this review artcle states, the evidence for TMS for most disorders is hardly compelling and even when the evidence is there, there are often better treatments. I'm also having a hard time seeing how TMS be an effective treatment for some of the listed conditions like, ALS (particularly the effects of ALS on the peripheral nervous system). Anyway, I suspect that the preponderance of evidence will show TMS is, at least currently, ineffective for many of the conditions listed so I think it is inaccurate to say "Some conditions which have been reported to be responsive to TMS-based therapy are..." Again I'll make the chances when I get the chance. JamesStewart7 (talk) 12:49, 18 August 2009 (UTC)

In research section inaccuracies
This "One reason TMS is important in cognitive psychology/neuroscience is that it can demonstrate causality." is inaccurate. rTMS is useful in demonstrating causality (convergent evidence is always nice) but they are not as conclusive as the article makes it sound. rTMS is often said to create virtual lessions but they are not really lesions. rTMS may block the activity of the area it is over but it does so by stimulating it at a high frequency. This means rTMS has the capacity to stimulate other areas of the brain by stimulating connected areas.

This conclusion is also somwehat questionable " Offline repetitive TMS, however, can be very susceptible to the placebo effect due to the contribution of dopamine.". This statment makes it sound like the placebo effect is somehow different in rTMS which the cited paper is insufficient to support. Changes in dopamine activity in that study could associated with a host of other changes and probably depend on how the placebo is administered etc just like every other placebo. I also doubt that rTMS is more susceptible to placebo than any other experimental manipulation which again the cited article is insufficient to support.

So I'm removing/adjusting the above information. The rest of the section is fairly accurate but could use some citations. I'll add them if I come across any JamesStewart7 (talk) 15:34, 18 August 2009 (UTC)

Actually regarding that above statement, I have noticed a few more things. This has been fact tagged for a while "Furthermore, a lack of effect is not conclusive." and I can't see why a lack of an effect is any less conclusive than an effect, disregarding problems with proving a negative in general. I don't know what this means "One disadvantage of this technique is that in addition to the location of stimulation, one also has to know when that part of the brain was involved in the task." as the location of stimulation should be the same as the brain region thougt to be involved in the task. As far as I know this is just not true; "The advantage of this technique is that any positive result can provide information about how and when the brain processes a task, since there is no time for a placebo effect or for other brain areas to compensate." as there is nothing to say a placebo or other expectancy effect cannot operate quickly. This is meaningless; "Additionally, the effects of repetitive TMS are variable between subjects and also for the same subject" as pretty much everything is variable within and across subjects.JamesStewart7 (talk) 15:40, 18 August 2009 (UTC)

More power to you James Stewart! It's like NeuroStar© corporation people are interfering.

Theta Burst Stimulation
I could only find one reference to TBS in this article, and think it could do with more coverage, even if it is only a variant of rTMS. Is there anybody who has experience with this technique who would be happy to cover this? —Preceding unsigned comment added by 94.171.113.55 (talk) 21:13, 19 December 2009 (UTC)

I have plenty of experience with TBS, but I don't think it deserves a more detailed explanation as it would be far too technical for wikipedia. -grushnik —Preceding unsigned comment added by 78.86.229.96 (talk) 23:40, 21 February 2010 (UTC)

Schutter & Hortensius, 2010
I removed the citation of this study since it involves tDCS, not TMS, and The magnetic field produced by TMS falls of rapidly with distance. The "retinal stimulation" theory also wouldn't explain the fact that phosphenes produced by occipital stimulation are retinotopically distributed in an arrangement similar to that of V1. Famousdog (talk) 09:18, 15 March 2010 (UTC)

controversy/negative opinions
I would like to see coverage of any controversy or negative opinions from the medical community added to the article. ike9898 (talk) 17:02, 23 April 2010 (UTC)


 * "Controversy or negative opinions" regarding what? Safety? There have been many safety studies of TMS (Wasserman, Chen et al, for example) and they have set clear safe limits for TMS and noted many contraindications against its use with, for example, epileptics. These aren't "negative" or "controversial" because pretty much everybody abides by them. Or are you talking about alt-med claims for its usefulness in aligning your chakras (ha ha)? What exactly are you after here? Famousdog (talk) 07:46, 26 April 2010 (UTC)

Deep TMS
In the section Therapy there are some lines about deep TMS. The sources are the company that "is dedicated to the development and marketing of Deep TMS" - this is a primary source. I will also remove this company's claim "with promising initial results". This can only be stated by secondary sources. I put an -tag behind the lines, but the question is if deep TMS should be mentioned at all. Lova Falk    talk   07:45, 13 July 2010 (UTC)


 * The trials were performed by independnt hospitals (Hadassah Ein-Kerem Medical Center, Jerusalem; Be'er Ya'akov Mental Health Center; Shalvata Medical Health Center, Hod-Hasharon, Israel). The results were published on a scientific journal . (More publication here .) Look at the footnote which suggests that while some of the authors "have financial interest in Brainsway Inc.", the others - its inferred - don't. I guess this is enough to establish reliability...? Floor tom (talk) 09:02, 13 July 2010 (UTC)
 * Sources for medical claims need to come from scientific journals, not company websites. WP:MEDRS.  WLU (t) (c) Wikipedia's rules: simple/complex 17:15, 14 July 2010 (UTC)


 * Again, there's a source from a scientific journal . Floor tom (talk) 08:45, 15 July 2010 (UTC)


 * That source does not appear on pubmed and further it is a primary source. Per WP:MEDRS, medical claims should be based on secondary sources - review articles.  Also, the company webpage is a) not a reliable source for medical claims and b) did not verify the text since it led to a very brief synopsis.  WLU (t) (c) Wikipedia's rules: simple/complex 10:28, 15 July 2010 (UTC)


 * Is that source valid then (as initial results)? Regarding the company webpage, it's not provided to verify medical claims, but merely as a reference that "treatment for a broad range of brain disorders are tested", and one should look at the left menu to see the list. These links   are better. Floor tom (talk) 11:15, 15 July 2010 (UTC)


 * Please review WP:MEDRS and see if the guideline supports these sources as appropriate to make medical claims. I do not believe it does.  WLU (t) (c) Wikipedia's rules: simple/complex 13:48, 15 July 2010 (UTC)


 * Well, WP:MEDRS states "If an important scientific result is so new that no reliable reviews have been published on it, it may be helpful to cite the primary source that reported the result." Floor tom (talk) 16:22, 15 July 2010 (UTC)

Undent. I would argue that this isn't an important result. It's seven people, there's no control group, and is merely an extension of principle. It's not a cure for AIDS, revolution in cancer, the Women's Health Initiative announcemen that HRT is actually harmful, etc. In my opinion, it's undue weight, borderline advertising, for a prospective treatment that hasn't been proplerly tested. I would recommend waiting until the results have been replicated, extended, and above all summarized in a review article. WLU (t) (c) Wikipedia's rules: simple/complex 17:26, 15 July 2010 (UTC)


 * I have no financial interest in Brainsway (although I can't prove it here), but I think that the new ability to reach deep inside the brain is very exciting as a prospective way to cure serious ills such as treatment-resistant depression. I would agree to omit the early results (BTW the other publication depicts a trial of 65 patients, although not yet double blind), but I think the novel feasibility to reach every region in the brain is worth mentioning in Wikipedia. Floor tom (talk) 19:20, 15 July 2010 (UTC)


 * I see your point about mentioning it but don't like the company source. Does Wassermann cover it at all that you know of?  If we're going for a brief description it's a far better source (also acceptable - any FDA source that mentions it, or a review article that covers, even briefly, deeper stimulation).  What I don't think should be done is a claim about successful treatment; perhaps the 7-person study could be used to verify basic information about dTMS without mentioning its specific study results (or mined for sources that discuss dTMS in greater detail).
 * I could try looking into it a bit more and possibly drafting a section, or if you'd like to have a go feel free to do so below here and I could comment. I'm unlikely to do any actual writing any time soon though.  WLU (t) (c) Wikipedia's rules: simple/complex 20:24, 15 July 2010 (UTC)


 * The book doesn't seem to mention it (see TOC and common terms here), but there're nih.gov sites that do, here and here. I'd suggest to restore the following paragraph, omitting the words "with promising initial results":
 * While Standard TMS coils are limited to activation of only cortical brain regions, up to a depth of about 1.5 cm, a new technology called Deep TMS (or dTMS) uses a coil design to produce directed electromagnetic fields that can induce excitation or inhibition of neurons deep inside the brain, including the limbic system, which is related to mood regulation. Treatment for a broad range of brain disorders are tested in this technique.clinicaltrials.gov, 16 July 2010
 * Floor tom (talk) 21:43, 15 July 2010 (UTC)


 * I've never liked using clinical trials.gov as a source since it's even more preliminary than an exploratory study. However, I did find this paper - which is nigh-perfect I think.  It's prospective, exploratory, full-text and makes no medical claims.  Not too old either.  WLU (t) (c) Wikipedia's rules: simple/complex 22:03, 15 July 2010 (UTC)


 * Great. I'll use it. Floor tom (talk) 22:59, 15 July 2010 (UTC)

General rewrite
I did a middling rewrite of the article, generally trimming the spam, kruft and fluff. Most sections are now sourced to reliable sources, but there's still work that could be done. The most controversial edit will doubtless be the FDA approval bit - the news article was a dead link, and the only thing I could find on the FDA website was a 2007 statement saying it wasn't approved. If we're going to cite FDA approval, we should link to the FDA website. I have no issue with the information being on the page, but it should be sourced to the FDA itself. WLU (t) (c) Wikipedia's rules: simple/complex 18:13, 14 July 2010 (UTC)

Ambiguity in the introductory paragraph.
The current introduction ( july 31, 2010) states: "Transcranial magnetic stimulation (TMS) is a noninvasive method to cause depolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents using a rapidly changing magnetic field; this can cause activity in specific or general parts of the brain with minimal discomfort, allowing the functioning and interconnections of the brain to be studied." As far as I can tell, "a rapidly changing magnetic field" is the basis for rTMS, and therefore the definition for rTMS is identical to the definition given for TMS. Someone please clarify. Tachyon 15:09, 31 July 2010 (UTC)

Study and FDA
The single person study is inappropriate per WP:MEDRS. Single subject designs are suspect because they're vulnerable to a lot more bias. It's already noted that they can cause seizures, there's no need to include the single subject source.

I'm not sure what the issue is with the FDA. We are supposed to use summary style rather than awkward full quotes. Quotes give consierable weight and are unnecessary in this case - I don't see a controversy where the agency's own words are needed to clarify. If it wasn't "approved" then you could substitute "permitted" or something equivalent. Two ugly block quotes are not necessary, a simple reword would be adequate. WLU (t) (c) Wikipedia's rules: simple/complex 20:29, 8 September 2010 (UTC)

MEDRS
Per WP:MEDRS, we are supposed to avoid primary sources. Though the study is interesting, it's not the kind of dramatic, important, paradigm- or treatment-changing information that we're supposed to cite primary sources for. It's relatively small, with a small clinical effect. I don't think that's worth including, though it'd be nice to have any sort of discussion about this.

The paper has been cited in an editorial by the way. That editorial, properly attributed, may be suitable for inclusion. I would need a full text version though. WLU (t) (c) Wikipedia's rules: simple/complex 14:07, 1 October 2010 (UTC)


 * The cited editorial cannot be read without a paid subscription. Furthermore, the editorial is not peer-reviewed. It is therefore not a reliable secondary source and is not suitable for a Wikipedia citation.150.148.0.65 (talk) 00:02, 2 October 2010 (UTC)
 * The fact that it's a paid subscription doesn't matter (WP:PAYWALL). Editorials are better quality sources than letters to the editor, and the sole comment existing on the article at this point.  I wouldn't suggest citing it without knowing what it actually says, but it is acceptable to state something like "In an accompanying editorial, X said Y about the study."  It's attributed to an editorial and person, but editorials are expected to represent the opinions of the editors and therefore respected professionals who have qualifications relevant to the journal and therefore article.  But it all depends what it says - it could merely be citing the article without giving more context.  WLU (t) (c) Wikipedia's rules: simple/complex 01:13, 2 October 2010 (UTC)

Use of primary sources in Wikipedia articles concerning scientific and medical subjects
WP:MEDRS states: "If an important scientific result is so new that no reliable reviews have been published on it, it may be helpful to cite the primary source that reported the result." Despite this, an editor (WLU) has repeatedly undone prior edits in Transcranial magnetic stimulation that have provided important information from recently published peer-reviewed scientific articles. In a recent instance, WLU undid information from a primary source with the comment that Wikipedia articles should cite information from a primary source "only in exceptional circumstances, and this ain't it."

However, WP:MEDRS does not state or even imply that an "important scientific result" from a primary source should be used "only in exceptional circumstances". Further, reasonable people may disagree on what is an "exceptional circumstance". Such judgements are subjective; Wikipedia articles are supposed to be objective.

In this particular instance, WLU has twice undone information from a recent publication (George et al. (2010)) that was the subject of an entire symposium at the May 2010 meeting of the American Psychiatric Association in New Orleans, LA. The publication certainly therefore reports a new "important scientific result". Editors that repeatedly remove such recent scientific information because they do not consider the information to be "exceptional" seriously diminish the usefulness of Wikipedia. I am therefore restoring the information from this publication. 150.148.0.65 (talk) 01:31, 2 October 2010 (UTC)
 * And I'll be removing it again - the entire section of MEDRS makes it clear that primary sources are to be used with care and thus in exceptions. We are indeed disagreeing on these exceptional circumstances and as you state - judgments are subjective and are made by editors through consensus.  Which means discussion rather than edit warring.  Wikipedia's articles can't be "objective" because that is impossible as everyone has a point of view.  Articles can, however, be neutral - which also requires discussion and consensus with representation through citation in reliable, secondary sources and general summary of the scientific mainstream - tricky.  It doesn't happen through anyone's bare assertion.  Whether this primary source is worth including requires discussion and though one of Wikipedia's great advantages is its ability to be fast (the "wiki" part of the name) it should be fastest through its ability to cite secondary sources rather than primary in most circumstances.  WP:RECENTISM, WP:CRYSTAL, WP:ADVOCACY, WP:SOAP, all are important nuances to what can be included in the page and all require judgment.
 * In the future, I have to request that you use the talk page sooner when disputes arise. This has been going back and forth for several months now and will continue unless all editors communicate - that includes both of us.  Since you're merely a wandering IP to me, I have no way of knowing how much editing experience you actually have - and this may be the first time you've ever looked at a talk page.  In the future, it's usually the best place to go when something contentious happens, and I really do thank you for engaging as you did in this section.  The majority of your changes are excellent and I take care to keep them.  Thank you for your attention to the page and for posting this message.  But this dispute, which is actually quite civil, has reached a wall and requires outside input.  Among our options are a third opinion, request for comment or posting at one of several venues - WP:NPOVN, WT:MED or WT:MEDRS.  I would suggest WT:MED because it would get the most traffic and there's a lot of medical experience there.  I would suggest a link to the main page, this section of the talk page, and if you have any available, a link to the symposium or any related correspondence or attention.
 * Note that I'm sincere about this requiring editorial judgment - it's very possible that the editors at WT:MED will consider this an important study and support its inclusion. Personally I don't think it's worth including but I could be convinced, or simply over-ridden by the weight of our peers.  Consensus means accepting the community's input, even if you disagree.  I'm going to bed now, I'll check back tomorrow morning.  Thanks, WLU (t) (c) Wikipedia's rules: simple/complex 01:34, 2 October 2010 (UTC)


 * The link to the symposium at the May 2010 meeting of the American Psychiatric Association (APA) is now gone, as the meeting was held several months ago. The co-chairs of the symposium were William M. McDonald and Mark S. George, both of whom were co-authors of the referenced publication.  According to the "Guide to the 2010 Annual Meeting", the symposium lasted for three hours and had six speakers. People may still be able to obtain hard copies of the "Guide" from the APA to verify this information.
 * This is not the first time that I have looked at or contributed to a Talk page. Unfortunately, my contributions have sometimes resulted in prolonged discussions that have wasted a lot of time for all concerned. That's the reason I don't often contribute to Talk pages.
 * In any event, my previous experiences with Wikipedia are irrelevant to this discussion. The relevant points here are: (1) the primary source is important enough to have merited an on-line editorial (unfortunately, not peer reviewed) that you cited above; (2) the article was the subject of a symposium at a major scientific meeting; and (3) the entire section of MEDRS contains no statements that "make it clear that primary sources are to be used .... in exceptions". In fact, the section states: "After enough time has passed for a review to be published in the area, the review should be cited in preference to the primary study. If no review is published in a reasonable amount of time, the primary source should be removed as not reporting an important result. When in doubt, omit mention of the primary study, as per WP:RECENTISM.?"
 * I am therefore restoring the information from George, et al., to the article. If no review is published in a reasonable amount of time, you may appropriately remove the primary source as not reporting an important result. But not until then. 150.148.0.65 (talk) 02:27, 2 October 2010 (UTC)
 * That's not a decision you can make alone, which is why I'm seeking outside input. I've requested some at WT:MED, in this section: Wikipedia talk:WikiProject Medicine.  WLU (t) (c) Wikipedia's rules: simple/complex 12:46, 2 October 2010 (UTC)
 * I'm posting here following the request for outside input at WT:MED. I'm impressed that both views have been expressed here so clearly, and I think both participants do understand the issues. Regular contributors to medical articles have developed a healthy scepticism for novel results based on single studies, and I'm sure 150.148.0.65 will appreciate the point of that. Most other areas of the 'pedia don't demand the same high standards of sourcing principally to reliable secondary sources, but medical articles do. Nevertheless, the study looks solid to me, and if anyone has access to the APA symposium, it might go a long way to establishing the credentials of the primary. Am I right to assume that the study does not refute the conclusions of recent secondary source? If it does, it should not be used; otherwise, on balance, my inclination would be weak support for 150.148.0.65's suggestion of including the text and the citation for the time being. I suggest that the situation is reviewed in a few months time, or sooner if further evidence is found confirming or refuting the study. This is only one opinion and I hope others will join in to help you both find an acceptable consensus. --RexxS (talk) 16:13, 2 October 2010 (UTC)
 * I, too, am responding to the message on WT:MED. 5.1% of the placebo control group experienced remission, 14.1% of the treatment group. Assuming 5.1% of the treatment remissions were spontaneous or a placebo response, that leaves 9% experiencing remission due to chance or TCMS. I just tossed a coin 100 times and got: heads = 42, tails = 58.


 * The results are promising, and will prompt efforts to replicate, but it is one study, and the results could easily be due to chance, fraud, error, or other. I believe it would be irresponsible to include this result in the article even with massive caveats. Anthony (talk) 18:27, 2 October 2010 (UTC)
 * I just read the whole article. (It was slack of me to comment before that and I apologise.) In context, the current wording does not give undue weight to the study's findings but flags the fact that a more convincing placebo is now available, which is an important step forward. I have no problem with it remaining as is. Anthony (talk) 07:33, 3 October 2010 (UTC)
 * I'm also here after seeing the request at WT:MED. I think this primary reference is garnering too much space due to the bulk of the authors' caveats.  It is appealing to use cautionary language for such a preliminary result.  It would be nice to have boilerplate for results that are interesting but far too preliminary for anything other than validation tests.  -- Scray (talk) 00:44, 3 October 2010 (UTC)


 * RexxS, it probably would refute the conclusions of an older review of older evidence, at least to some extent, so if used it would need to be worded cautiously, such as "more recent research,,,, from one study". Using a primary source more recent than a review is not quite the same as the older review has not reviewed the more recent research, hence why we are here trying to seek consensus to remove or keep this primary source.
 * I can see arguments for and against using the primary source and I can't make up my mind, partly because I am not familar enough with the topic matter. I actually know someone who participated in a clinical trial for this or something similar to this in France, which plucked my interest in commenting when I saw the posting for comments on WP:MED. It is an area which is likely to receive a fair amount of attention so I wouldn't be surprised if a review comes out in the next few months and I am sure further research will not be far away; any review or meta-analysis etc can replace the primary source if it is used.
 * When using a primary source, questions should be asked such as; does removing it or not adding it worsen or benefit the article? What is the quality of the study, methodology and patient size? Was study controlled? How controversial is the finding? Is the proposed text compliant with WP:UNDUE and WP:MEDRS? If it is poorly controlled but is making a high impact revolutionary change to scientific thinking then a primary source should probably not be used. If it is well controlled but making a controversial or revolutionary change to scientific thinking then caution should be exercised and concensus sought. And so forth. :)-- Literature geek |  T@1k?  00:45, 3 October 2010 (UTC)


 * In response to the above comments, I have added to the article a reference to an electronically-published review of the cited primary source, noting one of reviewer's conclusions. 150.148.0.65 (talk) 19:22, 4 October 2010 (UTC)
 * Diff for 150.148.0.65's above edit. Anthony (talk) 18:07, 6 October 2010 (UTC)

Treatment of chronic pain
Yes, I can see why therapeutic claims need to be supported by WP:MEDRS rather than just WP:RS. I also understand that neither a BBC television programme nor the website for the Pain Relief Foundation itself may be regarded as such. But the work of Prof. Nurmikko and his team with TMS seems to be well known. In this presentation work with TMS is summarised on pages 57-65.. Studies by Lefaucher et al (2004) and Fregni et al (2006) are quoted. I wonder if the inclusion of Nurmikko’s work in the BBC Horizon programme does not justify an inclusion elsewhere in this article, in terms that do not make any direct therapeutic claim? This seems to be very genuine “news” if nothing else, although I would expect there are papers in the Journal of Pain to inform any claims. Thanks Martinevans123 (talk) 18:27, 1 February 2011 (UTC)
 * For the sake of clarity, I'll provide relevant diffs: revert #1 and revert #2. Because this is an encyclopedia, not a news journal, it doesn't matter whether or not something is newsworthy.  If there are notable facts, verifiable in  reliable medical sources, then they may warrant inclusion.  -- Scray (talk) 00:22, 2 February 2011 (UTC)
 * Thank you for the link to the Horizon programme, Martin. Good old Beeb. I couldn't find anything in the PubMed index on Nurmikko's TMS work, but found this 2009 review in a good journal, so have inserted a summary. --Anthonyhcole (talk) 02:43, 2 February 2011 (UTC)
 * Thank you, That seems very fair. TMS seems to be only one facet of Nurmikko's work. Perhaps TMS work in this area will be properly published before too long. Yes, I had realised WP was not a news journal, although the inclusion of TMS is a mainsteam factual television programme seemed to me somewhat notable in itself. Martinevans123 (talk) 08:40, 2 February 2011 (UTC)

Refimprove still accurate?
In the 2 years since the Refimprove hatnote was added, the number of references has more than doubled (14 to 32) with the article staying about the same size. If anything, it looks like the "Technical Information" section might be a little sparse on citations, but I think it would be appropriate to take down the hatnote now and flag specific sections or sentences that need citations. &mdash;Merc64 (talk) 22:59, 5 April 2011 (UTC)

Study of children with ADHD
Someone who knows more than I is needed to place the following in the proper location within the article: http://clinicaltrials.gov/ct2/show/NCT00001915 It's diagnosis, has to do with ADHD, and also motor activity. --68.81.167.181 (talk) 17:42, 1 July 2011 (UTC)


 * This study says nothing about using TMS as a therapy for ADHD (as your edit seemed to suggest). It is using TMS to investigate the mechanisms of ADHD. Famousdog (talk) 11:17, 4 July 2011 (UTC)

TMS as a research tool
I came here seeking to know more about TMS in response to a paragraph in a recent book that mentions that an Australian neuroscientist named Alan Snyder is using it in experimental neuroscience. This appears to be a subject to add to the article.

--AJim (talk) 01:41, 22 August 2011 (UTC)

FDA Action
I ask recent contributors why they are reverting the text of the FDA action portion of this article? The current version provides an accurate summary of the de novo process with which a TMS device was cleared by the FDA in 2008. I would ask that contributors refrain from reverting text to an incomplete and inaccurate summary. — Preceding unsigned comment added by 75.150.159.145 (talk) 13:57, 22 December 2011 (UTC)

Effect Sizes: The numbers describing the meta-analysis of studies showing effect sizes of TMS for Major Depression don't make sense .NOTE:
"A recent meta-analysis ... showed an effect size of 0.55 (p<.001).[12] ...(the)...commonly reported effect sizes of pharmacotherapeutic strategies for treatment of depression in the range of 0.17-0.46.[12] However, that same meta-analysis found that rTMS was significantly worse than electroconvulsive therapy (effect size -0.47)" (?)...

Same problem occurs again: "(one)...meta-analysis showed that one extra remission from depression occurs for every 3 patients given electroconvulsive therapy rather than rTMS (number needed to treat 2.36).[20]"

The math makes no sense. Three patients treated with ECT yield one remission but rTMS requires less people treated to get the same result of one remission. Doesn't that imply that ECT was less effective; requiring the treatment of more patients to get a single remission? I'd like to hear about this backchannel. Henrysteinberger (talk) 14:45, 26 January 2012 (UTC)

Sham treatments
Does the term "sham treatments" under the heading Clinical Use refer to a placebo treatment, or does "sham" have another specific meaning here? It is just that sham seems to be an unusual and not very clear choice of word. My understanding of sham is something that is fraudulent or fake, or even messy. EG, "they made a sham of their presentation" or "don't buy that car, the add is a sham, you'll loose your money."

Where as placebo is a more moedical term such as "they took the placebo treatment". — Preceding unsigned comment added by 101.116.25.39 (talk) 04:29, 14 April 2012 (UTC)

Re-edit Please!
The flow of the page is confusing and it is also accumulating too much references to single studies added by self-publicists (no names) which have not been replicated. ==
 * I plan to reorganise the page into a section on history, how it works (the actual process in the clinic), proposed theories, controversy, and references to similar techniques DontCallMeShirley 15:12, 11 January 2006 (EST)

Lead image
Does File:Repetitive transcranial magnetic stimulation (rTMS) is a technique for noninvasive stimulation of the adult brain.jpg really give a fair indication/suggestion of the use (or usefulness) of the typical current applications of this technology? Martinevans123 (talk) 20:47, 16 April 2013 (UTC)

Medicare
This text, recently added, has now been removed: The conclusions of the AHRQ report were subsequently examined independently by the New England Comparative Effectiveness Public Advisory Council (CEPAC). CEPAC is an independent, 19-member organization composed of clinicians, patient and public health advocates, representatives of state public health programs and regional private payers from the New England states. The CEPAC Panel rigorously reviewed the quality of the evidence provided in the original AHRQ report, and extended the conclusions of that report by providing a detailed analysis of the anticipated direct impact on payer expenditures of providing TMS as a covered benefit. In a vote on the fundamental question: "For patients who have TRD, is the evidence adequate to demonstrate that rTMS provides a net health benefit equivalent or superior to usual care (i.e., general supportive psychotherapy with or without continued use of antidepressant medication)?" the CEPAC panel had a majority in support. In a vote on the separate question: “For patients who have TRD, is the evidence adequate to demonstrate that rTMS provides a net health benefit equivalent or superior to ECT?" the CEPAC Panel again had a majority in support.

Following a detailed economic analysis, the CEPAC panel noted that, using reasonable epidemiologically-based assumptions regarding the projected utilization of TMS in practice, on a per-member per-month (PMPM) basis, the cost impact to payers, of covering TMS, ranges from $0.21 - $0.59, or a relatively modest 0.07% - 0.20% increase in plan costs. This CEPAC process, together with the advocacy efforts by researchers, clinicians, and consumers in 2012, resulted in the approval for the New England region of the first Medicare coverage policy for TMS in the United States. Why is this material regarded as "unbalanced promotional discussion" and as "largely unrelated to subject of section"? Its relevance to Medicare seems inherently clear and also seems to be explicitly stated. If there are indeed "limitations of studies cited in references", then why not reiterate them, to provide balance, rather than remove the entire section? Thanks. Martinevans123 (talk) 18:46, 11 December 2013 (UTC)

Research use
From the article, one could get the impression that TMS is used almost exclusively for clinical purposes, whereas examinations of the clinical usage of TMS and its actual clinical usage is likely to be rare compared to its wide usage in research. There are many reviews and many more studies concerning the findings from TMS in several areas, particularly motor control and vision. It would be great if we could expand the article to reflect this. I'll try and start on this when I get the chance (my expertise is mainly in motor control) but it would be great if others could contribute to this also. Talket (talk) 11:28, 2 February 2014 (UTC)

add a section to article called EFFECTIVENES OF TMS
There should be a section of the article with the following information but I am not competent to pick throuh the scientific litterature.


 * Effectiveness of TMS
 * Effectiveness of TMS for the treatment of Depression
 * Effectiveness of TMS for the reatment of PTSD
 * effectiveness of TMS versus ECT

— Preceding unsigned comment added by 173.76.119.45 (talk • contribs) 22:44, 11 November 2010

Outside Opinion
I am a patient who has been receiving rTMS treatments from for severe depression since 1998. It's been my salvation - the only treatment that has worked for me. If you have any questions from a patient's point of view, my email is joan.miller AT post.harvard.edu. [jmmg18, 9/24/11] — Preceding unsigned comment added by 66.30.33.20 (talk • contribs) 18:27, 24 August 2005‎

transcranial direct current stimulation
New Scientist Article

— Preceding unsigned comment added by 146.244.137.168 (talk • contribs) 14:54, 12 April 2006

TMS as an interrogation/control
enhancing geek brains is one thing, directly controlling human value judgements to gain a military/police advantage is quite another: Scientific American article on the first success in magnetic mind control

— Preceding unsigned comment added by 209.226.103.184 (talk • contribs) 12:32, 6 October 2006

Massimini reference
I removed this at the end of TMS in Research section (add back if you can add the suitable connection to TMS):

Massimini et al. (Science, 2005)(Massimini M, Ferrarelli F, Huber R, Esser SK, Singh H, Tononi G. Breakdown of cortical effective connectivity during sleep. Science. 2005 Sep 30;309(5744):2228-32.) used EEG to show that during sleep, brain areas do not pass signals to other brain areas as effectively as during wakefulness.

— Preceding unsigned comment added by Lostart (talk • contribs) 20:38, 25 April 2006

TMS research is multi-disciplinary
Of course, physicists and engineers are involved in TMS research. In my lab, medics collaborate with engineers, neuroscientists, psychologists, medical physicists and mathematicians. Modelling papers on TMS fields are published in engineering and medical journals (just look up Pubmed), and the companies building these devices are engineers too trying to improve their product line.

— Preceding unsigned comment added by Grushnik (talk • contribs) 21:26, 24 November 2007